Alexander disease (AxD) is a rare autosomal dominant leukodystrophy due to pathogenic variants in glial fibrillary acidic protein (GFAP). Adult-onset AxD type II presents with heterogeneous neurologic and neuropsychiatric symptoms. We report a unique case diagnosed in the postpartum period that mimicked posterior reversible encephalopathy syndrome (PRES). A 33-year-old gravida 2 para 1 at 36 weeks gestation presented with 10 days of progressive restlessness, delusions, insomnia, dysarthria, weight loss with inability to feed herself, and urinary/fecal incontinence. She underwent induction of labor due to concern for severe pre-eclampsia (elevated liver enzymes and creatine kinase, elevated blood pressure), received magnesium sulfate, and required emergent cesarean delivery for non-reassuring fetal status. However, her symptoms persisted postpartum. Brain magnetic resonance imaging revealed extensive bifrontal, periventricular, and pontine non-enhancing hyperintensities. Cerebrospinal fluid analysis was normal including negative infectious, autoimmune, and paraneoplastic studies. Electroencephalography showed mild background slowing but no epileptiform activity. Empiric methylprednisolone and acyclovir had limited effects. Given the imaging findings, a leukodystrophy panel was ordered, which identified a heterozygous pathogenic GFAP variant (Arg79Leu), confirming a diagnosis of AxD type II. She improved with rehabilitation, with mild residual dysarthria at the 2-month follow-up. This is the first case report to describe an onset of AxD in the peripartum period. In peripartum patients with neurological symptoms whose course and MRI findings are atypical for PRES or other more common disorders, adult-onset neurogenetic disorders such as AxD should be considered. This diagnosis has important reproductive implications and warrants genetic counseling.

Leptomeningeal metastasis (LM) is a rare complication of esophageal adenocarcinoma, with reported cases typically presenting with meningitic, encephalopathic, or multifocal neurologic symptoms. We report a 70-year-old man with metastatic esophageal adenocarcinoma with signet-ring cell features who developed subacute, painless, bilateral visual loss with bilateral optic disc edema as the initial manifestation of probable LM. Symptoms arose four months into first-line folinic acid, fluorouracil, and oxaliplatin (FOLFOX) plus pembrolizumab while all measurable extracranial disease was responding and in the absence of headache, meningismus, or other neurologic symptoms. Contrast-enhanced MRI demonstrated bilateral optic nerve sheath enhancement with subtle linear leptomeningeal enhancement over the cerebral convexities and no parenchymal brain metastases. Over the ensuing days, the patient developed urinary incontinence, gait instability, lower-extremity weakness, and cognitive decline. Cerebrospinal fluid analysis showed markedly elevated protein, lymphocytic pleocytosis, normal glucose, and rare atypical cells suspicious for malignancy; flow cytometry and cultures were negative. Although CSF cytology was not definitively diagnostic, the combined clinical presentation, characteristic MRI findings, and supportive CSF abnormalities in the setting of known metastatic malignancy were consistent with probable LM. Whole-brain radiotherapy was initiated but discontinued after one fraction because of rapid neurologic deterioration, and the patient died four weeks after the diagnosis. This case highlights an unusual presentation of probable LM in esophageal adenocarcinoma, with subacute painless bilateral visual loss and optic disc edema preceding other neurologic manifestations despite concurrent extracranial disease response.

Urinary incontinence (UI), an involuntary loss of urine, is a widespread pelvic floor disorder affecting 20-50% of women worldwide, with a 21% prevalence in Sub-Saharan Africa. Contributing factors include genetics, childbirth, and chronic conditions, leading to significant physical, social, and emotional challenges such as fear of leakage and isolation. Despite its impact, many affected women lack awareness of UI and available treatments, which include medication, surgery, and pelvic floor muscle training (PFMT). Knowledge gaps and misconceptions persist, hindering timely diagnosis and management. In response to these challenges, healthcare systems in Africa are adopting digital technologies (DTs), including WhatsApp and social media, to facilitate patient education and professional collaboration. Studies indicate that digital platforms can support women in managing UI, particularly through PFMT. However, little is known about women's digital health education needs, barriers, and platform preferences. This study explored these aspects among women with UI in Kigali through a phenomenological qualitative approach across four hospitals: Masaka, Rwanda Military, Kibagabaga, and King Faisal. Using purposive sampling, 20 women aged 20-70 were selected. Data analysis was conducted through thematic analysis using deductive and inductive coding. The findings revealed four key themes. First, there are significant knowledge gaps about UI, necessitating multimodal education to address misinformation and misconceptions. Second, participants regularly use digital devices and the internet, recognizing their benefits and affordability for accessing health information. Third, barriers to digital health education included distrust in the accuracy of online information and financial constraints in maintaining digital devices and internet services. Lastly, participants expressed a strong interest in multimodal digital health education platforms to receive UI-related information. Many women misunderstood UI, often confusing it with aging or other conditions, leading to delayed diagnosis, emotional distress, social withdrawal, financial strain, and reduced quality of life. Although digitally literate, they rarely sought digital health information on UI due to knowledge gaps, financial limitations, and skepticism about online sources. The study underscores the urgent need for accessible and trustworthy digital health education to bridge knowledge gaps, provide support, and enhance UI management among affected women.

Background There is a pressing need among individual surgeons and busy clinics for a time-efficient method to record, assess, and monitor cases going to surgery. Purpose To develop a compact, symptom-based, simplified diagnostic model and database, designed to be sufficiently comprehensive, accurate and predictive of causation to guide pelvic floor surgeries and monitor their results postoperatively. Methods We condensed the four parts of the validated comprehensive Integral Theory Diagnostic System into a 10-minute assessment, including QOL and "simulated operations" to test the possibility of ligamentous origins of SUI, OAB and chronic pelvic pain. Results The pilot model was tested in 109 women, 82 with pelvic organ prolapse and 27 with stress urinary incontinence (SUI) from a busy urogynecology clinic. The model succeeded in what it was planned to do: record symptoms in a database, deduce possible ligament causation of symptoms and observed prolapses graded simply I-IV, all within 10 minutes. Initial testing for monitoring post-operative anatomical and symptom results is promising. Conclusions The model has been found to be helpful as a clinical guide. It is now in general use for all planned incontinence and prolapse surgeries. It records symptoms, prolapses and diagnoses, and potential connective tissue causation for SUI, urge and pain, which is then tested. The simplified database is a low-cost monitoring system for incontinence and prolapse surgery, especially useful for an individual surgical practice and low-resource clinics. Being symptom-based, the model is amenable to tailoring for individual practices and institutions.